• Gunnar Waage Skjeflo, Trond Nordseth, Jan Pål Loennechen, Daniel Bergum, and Eirik Skogvoll.
• Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway. Electronic address: gunnar.w.skjeflo@ntnu.no.
• Resuscitation. 2018 Jun 1; 127: 31-36.

BackgroundPulseless electrical activity (PEA) is a frequent initial rhythm in cardiac arrest, and ECG characteristics have been linked to prognosis. The aim of this study was to examine the development of ECG characteristics during advanced life support (ALS) and cardiopulmonary resuscitation (CPR) in cardiac arrest with initial PEA, and to assess any association with survival.MethodsPatients with in-hospital cardiac arrest with initial PEA at St. Olav Hospital (Trondheim, Norway) over a three-year period were included. A total of 2187 combined observations of QRS complex rate (heart rate) and QRS complex width for the duration of ALS were determined from defibrillator recordings from 74 episodes of cardiac arrest.ResultsIncreasing heart rate and decreasing QRS complex width during ALS was significantly more prevalent in patients who obtained return of spontaneous circulation compared to patients who were declared dead.ConclusionChanges in ECG characteristics during ALS in cardiac arrest presenting as PEA are related to prognosis. An increase in heart rate was observed in the last 3-6 min before ROSC was obtained.Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

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